Thyroid

Question 1

Thyrotoxic Crisis (Thyroid Storm)

Answer 1

Overwhelming release of thyroid hormones that exerts an intense stimulus on the METABOLISM

Rare, life-threatening condition most commonly precipitated by

1. Surgery
2. Trauma
3. Infection

Question 2

Thyroid Storm: Risk Factors

Answer 2

• long standing untreated hyperthyroidism (graves’ disease)
• Acute event (surgery, trauma, infection)
• Irregular use or discontinuation of Antithyroid drugs

Question 3

Thyroid Storm Manifestations

Answer 3

1. High Fever
2. Tachycardia >140
3. N/V
4. Agitation
5. Tremor
6. Psychosis
7. Stupor/Coma
8. HTN leading to&raquo_space; Hypotension (HR way too high for CO)

Question 4

Treatment for Thyroid Storm

Answer 4

1. Beta blocker: controls S/S induced by increased adrenergic tone, given (q 6hrs)
2. Thionamide (Propylthiouracil/PTU): to block new hormone synthesis, suppresses conversion of T4 to T3, (q 4hrs)
3. Iodine solution: to block the release of thyroid hormone
4. Glucocorticoids: to reduce T4 to T3 conversion, promote vasomotor stability, and possibly treat an associated relative adrenal insufficiency, (q 8hrs)
5. Bile acid sequestrants: may benefit in severe cases to decrease enterohepatic circulation and recycling of thyroid hormones, (q 6 hrs)

Question 5

Myxedema

Answer 5

Severe HYPOTHYROIDISM leading to:

1. decreased mental status
2. hypothermia
3. slowing function of other organs

Medical emergency with high mortality rate

Uncommon due to earlier diagnosis capability

Question 6

Myxedema RF:

Answer 6

Hypothyroidism

1. Long standing and severe form
2. Precipitating acute event in poorly controlled pt. with hypothyroidism
   (infections, MI, Cold exposure, surgery)
3. Sedative drugs (opioids)

Question 7

S/S of Myxedema

Answer 7

• Decreased mental status (Coma)
• Hypothermia
• Hypotension
• Bradycardia
• Hyponatremia (dilutional)
• Hypoglycemia
• Hypoventilation

Question 8

Treatment for Myxedema

Answer 8

1. Thyroid hormone (levothyroxine + liothyronine)
   - IV, slow bolus then daily doses
2. Glucocorticoids
   - IV, dose q 8 hours
3. Supportive measures
   - ICU, IV fluids, electrolyte replacement, mechanical ventilation, glucose monitoring and replacement, correction of hypothermia, treat underlying infection (if cause)